1104049063 NPI number — MS. ALLEGRA JACQUELINE HAMMAN CRNP

Table of content: MS. ALLEGRA JACQUELINE HAMMAN CRNP (NPI 1104049063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104049063 NPI number — MS. ALLEGRA JACQUELINE HAMMAN CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMMAN
Provider First Name:
ALLEGRA
Provider Middle Name:
JACQUELINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104049063
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10753 FALLS RD
Provider Second Line Business Mailing Address:
JOHNS HOPKINS AT GREEN SPRING SUITE 315
Provider Business Mailing Address City Name:
LUTHERVILLE TIMONIUM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-4535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-583-2926
Provider Business Mailing Address Fax Number:
410-583-2883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10753 FALLS RD
Provider Second Line Business Practice Location Address:
JOHNS HOPKINS AT GREEN SPRING SUITE 315
Provider Business Practice Location Address City Name:
LUTHERVILLE TIMONIUM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-4535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-583-2926
Provider Business Practice Location Address Fax Number:
410-583-2883
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  R109043 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 570039600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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